Search

Purpose: The purpose of this study is to study the evolution of quality of life (QoL) in the first 5 years following Intensity-modulated radiation therapy (IMRT) for prostate cancer (PCa) and to determine possible associations with clinical/treatment data. Material and methods: Patients were enrolled in a prospective multicentre observational trial in 2010-2014 and treated with conventional (74–80 Gy, 1.8–2 Gy/fr) or moderately hypofractionated IMRT (65–75.2 Gy, 2.2–2.7 Gy/fr). QoL was evaluated by means of EORTC QLQ-C30 at baseline, at radiation therapy (RT) end, and every 6 months up to 5 years after IMRT end. Fourteen QoL dimensions were investigated separately. The longitudinal evaluation of QoL was analysed by means of Analysis of variances (ANOVA) for multiple measures. Results: A total of 391 patients with complete sets of questionnaires across 5 years were available. The longitudinal analysis showed a trend toward the significant worsening of QoL at RT end for global health, physical and role functioning, fatigue, appetite loss, diarrhoea, and pain. QoL worsening was recovered within 6 months from RT end, with the only exception being physical functioning. Based on ANOVA, the most impaired time point was RT end. QoL dimension analysis at this time indicated that acute Grade ≥ 2 gastrointestinal (GI) toxicity significantly impacted global health, physical and role functioning, fatigue, appetite loss, diarrhoea, and pain. Acute Grade ≥ 2 genitourinary (GU) toxicity resulted in lower role functioning and higher pain. Prophylactic lymph-nodal irradiation (WPRT) resulted in significantly lower QoL for global health, fatigue, appetite loss, and diarrhoea; lower pain with the use of neoadjuvant/concomitant hormonal therapy; and lower fatigue with the use of an anti-androgen. Conclusions: In this prospective, longitudinal, observational study, high radiation IMRT doses delivered for PCa led to a temporary worsening of QoL, which tended to be completely resolved at six months. Such transient worsening was mostly associated with acute GI/GU toxicity, WPRT, and higher prescription doses.

IntroductionThe correct labeling of a genetic variant as pathogenic is important as breeding decisions based on incorrect DNA tests can lead to the unwarranted exclusion of animals, potentially compromising the long-term health of a population. In human medicine, the American college of Medical Genetics (ACMG) guidelines provide a framework for variant classification. This study aims to apply these guidelines to six genetic variants associated with hypertrophic cardiomyopathy (HCM) in certain cat breeds and to propose a modified criterion for variant classification.MethodsGenetic samples were sourced from five cat breeds: Maine Coon, Sphynx, Ragdoll, Devon Rex, and British Short- and Longhair. Allele frequencies were determined, and in the subset with phenotypes available, odds ratios to determine the association with HCM were calculated. In silico evaluation followed with joint evidence and data from other publications assisting in the classification of each variant.ResultsTwo variants, MYBPC3:c.91G > C [A31P] and MYBPC3:c.2453C > T [R818W], were designated as pathogenic. One variant, MYH7:c.5647G > A [E1883K], was found likely pathogenic, while the remaining three were labeled as variants of unknown significance.DiscussionRoutine genetic testing is advised solely for the MYBPC3:c.91G > C [A31P] in the Maine Coon and MYBPC3:c.2453C > T [R818W] in the Ragdoll breed. The human ACMG guidelines serve as a suitable foundational tool to ascertain which variants to include; however, refining them for application in veterinary medicine might be beneficial.

Abstract Whether clinical practice guidelines have a significant impact on practice is unclear. The effect of guideline recommendations on clinical practice often a lags behind the date of publication. We evaluated by means of a data-driven approach if and when the guidelines on red blood cell transfusions (RBCTs) issued by Swiss Smarter Medicine in 2016 had an impact on RBCTs practice within a hospital network, where awareness of guidelines was promoted mainly among internal medicine specialties. Data on RBCTs performed in a Swiss hospital network from January 2014 to April 2021 were analyzed by hospital site and specialty to assess whether guidelines led to a decrease in inappropriate RBCTs. RBCTs were defined as “inappropriate” if patients had a hemoglobin level ≥ 70 g/L without or ≥ 80 g/L with significant cardiovascular comorbidities. Changes in the rate of inappropriate transfusions were analyzed with an advanced statistical approach that included generalized additive models. Overall prior to March 2017 there were more inappropriate than appropriate RBCTs, but after October 2017 the opposite could be observed. A change-point in the time trend was estimated from transfusion data to occur in the time interval between March and October 2017. This change was mainly driven by practice changes in the medical wards, while no significant change was observed in the critical care, surgical and oncology wards. Change in practice varied by hospital site. In conclusion, our results show that a significant change in the RBCTs practice at the hospital level occurred approximately 18 months after national guidelines were issued.

In a LoRaWAN network, the backend is generally distributed as Software as a Service (SaaS) based on container technology, and recently, a containerized version of the LoRaWAN node stack is also available. Exploiting the disaggregation of LoRaWAN components, this paper focuses on the emulation of complex end-to-end architecture and infrastructures for smart city scenarios, leveraging on lightweight virtualization technology. The fundamental metrics to gain insights and evaluate the scaling complexity of the emulated scenario are defined. Then, the methodology is applied to use cases taken from a real LoRaWAN application in a smart city with hundreds of nodes. As a result, the proposed approach based on containers allows for the following: (i) deployments of functionalities on diverse distributed hosts; (ii) the use of the very same SW running on real nodes; (iii) the simple configuration and management of the emulation process; (iv) affordable costs. Both premise and cloud servers are considered as emulation platforms to evaluate the resource request and emulation cost of the proposed approach. For instance, emulating one hour of an entire LoRaWAN network with hundreds of nodes requires very affordable hardware that, if realized with a cloud-based computing platform, may cost less than USD 1.

IntroductionAtrial fibrillation secondary to dilated cardiomyopathy (DCM) frequently affects large-breed dogs. The aim of the present study was to identify risk factors for the development of atrial fibrillation in dogs of different breeds with an echocardiographic diagnosis of DCM.MethodsIn this multicenter retrospective study, we searched the electronic databases of five cardiology referral centers for dogs with an echocardiographic diagnosis of DCM. A comparison of clinical and echocardiographic variables was performed between dogs developing atrial fibrillation and those not developing atrial fibrillation and the ability to distinguish between these two groups of dogs was evaluated by receiver operating characteristic curve analysis. Univariate and multivariable logistic regression analysis estimated the odds ratio (OR) with 95% confidence interval (CI) of developing atrial fibrillation.ResultsWe included 89 client-owned dogs with occult and overt echocardiographic DCM. Of these, 39 dogs (43.8%) had atrial fibrillation, 29 dogs (32.6%) maintained a sinus rhythm, and 21 dogs (23.6%) showed other cardiac arrhythmias. Left atrial diameter had high accuracy (area under the curve = 0.816, 95% CI = 0.719–0.890) to predict the development of atrial fibrillation at the cut-off of >4.66 cm. After multivariable stepwise logistic regression analysis, only increased left atrial diameter (OR = 3.58, 95% CI = 1.87–6.87; p < 0.001) and presence of right atrial enlargement (OR = 4.02, 95% CI = 1.35–11.97; p = 0.013) were significant predictors of atrial fibrillation development.DiscussionAtrial fibrillation is a common complication of DCM in the dog and is significantly associated with increased absolute left atrial diameter and right atrial enlargement.

Preventing pathogens from entering and spreading on farms is the first step in reducing health problems. For this study a BiosEcurity Assessment Tool was developed to identify strengths and weaknesses in biosecurity on broiler farms, which was used as a starting point to formulate tailor-made health plans to improve broiler health and reduce antimicrobial use. Farms were divided into 3 separate areas according to associated biosecurity risk; high disease risk external areas (red zone), medium risk service areas (orange zone), and the clean and highly secure access-restricted green zone. In the Netherlands, Cyprus, and Greece, 13, 15, and 7 broiler houses were monitored for 4 production cycles (2 preintervention and 2 postintervention cycles). At the start of the study the BiosEcurity Assessment Tool assessment was performed and a health plan was made in consultation with the veterinarian. After the second cycle a start was made with the implementation of the health plan. Overall, the biosecurity level in the green and orange zones were significantly higher in the Netherlands compared to Greece and Cyprus, but there was no difference for the red zone or the transition zones between the countries. The interventions in the health plans were mostly directed towards those measures that could be implemented in the short term and with low costs in the green zone. In Cyprus a decrease in antimicrobial use was found postintervention. This was not the case in Greece and the Netherlands. In Cyprus and Greece footpad lesion improved after interventions were implemented, although this may have been an effect of season. In Dutch farms no improvement was detected, but both antimicrobial use and footpad lesions were lower at the start of the study compared to Cypriot and Greek farms. In conclusion, the BEAT shows to be a promising tool to assess biosecurity risks on broiler farms. The biosecurity assessment in combination with the farm specific health plans could contribute to antimicrobial reduction on broiler farms.

Summary: Memory B cells (MBCs) generate rapid antibody responses upon secondary encounter with a pathogen. Here, we investigated the kinetics, avidity, and cross-reactivity of serum antibodies and MBCs in 155 SARS-CoV-2 infected and vaccinated individuals over a 16-month time frame. SARS-CoV-2-specific MBCs and serum antibodies reached steady-state titers with comparable kinetics in infected and vaccinated individuals. Whereas MBCs of infected individuals targeted both prefusion and postfusion Spike (S), most vaccine-elicited MBCs were specific for prefusion S, consistent with the use of prefusion-stabilized S in mRNA vaccines. Furthermore, a large fraction of MBCs recognizing postfusion S cross-reacted with human betacoronaviruses. The avidity of MBC-derived and serum antibodies increased over time resulting in enhanced resilience to viral escape by SARS-CoV-2 variants, including Omicron BA.1 and BA.2 sublineages, albeit only partially for BA.4 and BA.5 sublineages. Overall, the maturation of high-affinity and broadly reactive MBCs provides the basis for effective recall responses to future SARS-CoV-2 variants.

BackgroundRed blood cell (RBC) transfusions in surgical patients are associated with increased morbidity a hospital stay. However, little is known about how clinical and economic outcomes differ between appropriately and inappropriately transfused patients. We hypothesized that inappropriate RBC transfusions in elective surgical patients would significantly increase hospital cost. The aim of this study was to quantify the economic burden associated with inappropriate RBC transfusions.MethodsWe retrospectively included all adult patients admitted for elective non-cardiac surgery between January 2014 and March 2020. Patients were divided into three groups (not transfused, appropriately transfused and inappropriately transfused). The primary outcome was the excess in hospital cost in patients inappropriately transfused compared to non-transfused patients. Costs were calculated using a bottom–up approach and involving cost calculation on a granular level. According to international guidelines, transfusions were considered appropriate if administered with an ASA score of 1–2 and the last hemoglobin level measured before transfusion < 70 g/L, or with an ASA score ≥ 3 and the last hemoglobin level < 80 g/L. Cases where RBC transfusions were deemed necessary regardless of the Hb levels were reviewed by the patient blood management (PBM) board and classified accordingly. Secondary outcomes included total transfusion rate, transfusion index, and length of hospital stay. Statistical analysis was carried out by multivariable regression models.ResultsDuring the study period there were 54,922 consecutive surgical admissions, of these 1,997 received an RBC transfusion, with 1,125 considered inappropriate. The adjusted cost of each inappropriate RBC transfusions was estimated in United States dollars (USD) 9,779 (95% CI, 9,358 – 10,199; p < 0.001) and totaled USD 11,001,410 in our series. Inappropriately transfused patients stayed 1.6 times (95% CI, 1.5–1.6; p < 0.001) longer in hospital (10.6 days vs. 6.7 days) than non-transfused patients and a mean 2.35 RBC units per patient were administered.ConclusionInappropriate RBC transfusions in elective surgical patients seem to be common and may represent a significant economic burden. In our experience, inappropriate transfusions significantly increased hospital costs by an average of USD 9,779 compared to non-transfused patients. Through specific PBM policy, hospitals may improve cost-effectiveness of their elective surgical activity by lowering inappropriate transfusions.

In livestock, the importance of hygiene management is gaining importance within the context of biosecurity. The aim of this study was to monitor the implementation of biosecurity and hygiene procedures in 20 swine herds over a 12-month period, as driven by tailor-made plans, including training on-farm. The measure of adenosine triphosphate (ATP) environmental contents was used as an output biomarker. The presence of livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) and extended-spectrum β-lactamase producing Escherichia coli (ESBL-E. coli) was also investigated as sentinels of antibiotic resistance. A significant biosecurity improvement (p = 0.006) and a reduction in the ATP content in the sanitised environment (p = 0.039) were observed. A cluster including 6/20 farms greatly improved both biosecurity and ATP contents, while the remaining 14/20 farms ameliorated them only slightly. Even if the ESBL-E. coli prevalence (30.0%) after the hygiene procedures significantly decreased, the prevalence of LA-MRSA (22.5%) was unaffected. Despite the promising results supporting the adoption of tailor-made biosecurity plans and the measure of environmental ATP as an output biomarker, the high LA-MRSA prevalence still detected at the end of the study underlines the importance of improving even more biosecurity and farm hygiene in a one-health approach aimed to preserve also the pig workers health.

The aims of the present study were to obtain sleep quality and sleep timing information in a group of university students and to evaluate the effects of a circadian hygiene education initiative. All students of the University of Padova (approximately 64,000) were contacted by e-mail (major campaigns in October 2019 and October 2020) and directed to an ad hoc website for collection of demographics and sleep quality/timing information. Participants (n = 5,740) received one of two sets of circadian hygiene advice (“A regular life” or “Bright days and dark nights”). Every month, they were then asked how easy it had been to comply and provided with the advice again. At any even month from joining, they completed the sleep quality/timing questionnaires again. Information on academic performance was obtained post hoc, together with representative samples of lecture (n = 5,972) and examination (n = 1,800) timings, plus lecture attendances (n = 25,302). Fifty-two percent of students had poor sleep quality, and 82% showed signs of social jetlag. Those who joined in October 2020, after several months of lockdown and distance learning, had better sleep quality, less social jetlag, and later sleep habits. Over approximately a year, the “Bright days and dark nights” advice resulted in significantly earlier get-up times compared with the “A regular life” advice. Similarly, it also resulted in a trend toward earlier midsleep (i.e., the midpoint, expressed as clock time, between sleep onset and sleep offset) and toward a decrease in the latency between wake-up and get-up time, with no impact on sleep duration. Significant changes in most sleep quality and sleep timing variables (i.e., fewer night awakenings, less social jetlag, and delayed sleep timing during lock-down) were observed in both advice groups over approximately a year, mostly in association with pandemic-related events characterizing 2020. Early chronotype students had better academic performances compared with their later chronotype counterparts. In a multivariate model, sleep quality, chronotype and study subject (science and technology, health and medical, or social and humanities) were independent predictors of academic performance. Taken together, these results underlie the importance of designing circadian-friendly university timetables.

Patients on dialysis are at risk of severe course of SARS-CoV-2 infection. Understanding the neutralizing activity and coverage of SARS-CoV-2 variants of vaccine-elicited antibodies is required to guide prophylactic and therapeutic COVID-19 interventions in this frail population. By analyzing plasma samples from 130 hemodialysis and 13 peritoneal dialysis patients after two doses of BNT162b2 or mRNA-1273 vaccines, we found that 35% of the patients had low-level or undetectable IgG antibodies to SARS-CoV-2 Spike (S). Neutralizing antibodies against the vaccine-matched SARS-CoV-2 and Delta variant were low or undetectable in 49% and 77% of patients, respectively, and were further reduced against other emerging variants. The fraction of non-responding patients was higher in SARS-CoV-2-naïve hemodialysis patients immunized with BNT162b2 (66%) than those immunized with mRNA-1273 (23%). The reduced neutralizing activity correlated with low antibody avidity. Patients followed up to 7 months after vaccination showed a rapid decay of the antibody response with an average 21- and 10-fold reduction of neutralizing antibodies to vaccine-matched SARS-CoV-2 and Delta variant, which increased the fraction of non-responders to 84% and 90%, respectively. These data indicate that dialysis patients should be prioritized for additional vaccination boosts. Nevertheless, their antibody response to SARS-CoV-2 must be continuously monitored to adopt the best prophylactic and therapeutic strategy.

The Internet of Things (IoT) approach relies on the use of the Internet Protocol (IP) as a pervasive network protocol. IP acts as a “glue” for interconnecting end devices (on the field side) and end users, leveraging on very diverse lower-level and upper-level protocols. The need for scalability would suggest the adoption of IPv6, but the large overhead and payloads do not match with the constraints dictated by common wireless solutions. For this reason, compression strategies have been proposed to avoid redundant information in the IPv6 header and to provide fragmentation and reassembly of long messages. For example, the Static Context Header Compression (SCHC) protocol has been recently referenced by the LoRa Alliance as a standard IPv6 compression scheme for LoRaWAN-based applications. In this way, IoT end points can seamlessly share an end-to-end IP link. However, implementation details are out of the specifications’ scope. For this reason, formal test procedures for comparing solutions from different providers are important. In this paper, a test method for assessing architectural delays of real-world deployments of SCHC-over-LoRaWAN implementations is presented. The original proposal includes a mapping phase, for identifying information flows, and a subsequent evaluation phase, in which flows are timestamped and time-related metrics are computed. The proposed strategy has been tested in different use cases involving LoRaWAN backends deployed all around the world. The feasibility of the proposed approach has been tested by measuring the end-to-end latency of IPv6 data in sample use cases, obtaining a delay of less than 1 s. However, the main result is the demonstration that the suggested methodology permits a comparison of the behavior of IPv6 with SCHC-over-LoRaWAN, allowing the optimization of choices and parameters during deployment and commissioning of both infrastructure components and software.

Antimicrobial residues may pose harmful effects on the health of consumers. At the same time, an adequate quality of drinking water for animals is one of the important element to ensure animal welfare and food without antibacterials. The presented study is aimed at estimating the residue levels of antibacterial compounds, such as penicillins, cephalosporin, macrolides, tetracyclines, quinolones, sulphonamides, aminoglycosides, diaminopirymidines, pleuromutilines and lincosamides in meat and on-farm drinking water samples using liquid chromatography-tandem mass spectrometry (LC-MS/MS), as a part of a surveillance system on pig and broiler farms within the project Healthy Livestock. A total of 870 samples of muscle from pig and broiler, as well as 229 water samples were analysed for antibiotic residues. Samples were collected from farms in EU countries in two steps, before and after implementation of a tailor-made health plan. In muscle samples, the detected concentrations of doxycycline in the post-intervention step (15.9–70.8 µg/kg) were lower than concentrations in the pre-intervention step (20.6–100 µg/kg). In water samples, doxycycline in an average concentration of 119 µg/L in the pre- and 23.1 µg/L in the post-intervention step, as well as enrofloxacin at concentrations of 170 µg/L in the pre- and 1.72 µg/L in the post-intervention step were quantified. Amoxicillin was only present before intervention. The obtained results confirm the effectiveness of the intervention actions. The concentrations of antibiotics in muscles and water were lower after implementation of a health plan on the farms.

To evaluate the nutrient load due to the grazing of laying hens in outdoor runs, monitoring of soil characteristics was conducted in three Italian organic farms. For each farm, soil samples were taken from three increasing distances from the hen house and two depths, and different chemical parameters were evaluated. The comparison among the results from the different distances shows that N-NO3 and Olsen P are the most affected parameters by hen feces: both present high values with a statistically significant difference in the area close to the poultry house and for the most superficial layer. Even TKN and TOC show significant differences between the concentrations of the first layer (more concentrated) and those of the second layer (less concentrated). In general, the surface soil layer closest to the chicken house is the portion of the outdoor run most affected by chicken droppings and represents the most critical point in terms of potential environmental impact. Therefore, it is necessary to intensify the management of the outdoor run with tools that can facilitate the grazing of animals and with vegetation that can absorb nutrients by limiting leaching and runoff.

Limited data are available regarding animal-based biomarkers over time as outcomes of biosecurity in pig farms. The aim of this study was to gain an insight into the biosecurity implementation in a convenience sample of 15 swine herds, and to describe potential biomarkers of interest; inputs from a systematic evaluation of biosecurity implementation were used to develop tailor-made biosecurity protocols monitored over a 12-month period. The farms’ implementation was then described, and animal-based biomarkers were explored as output parameters. A significative biosecurity improvement was observed at the end of the study (p = 0.047), in particular in the professional zone (p = 0.012). Four clusters of farms were identified for their progress on biosecurity implementation by means of Principal Component Analysis (PCA) and Hierarchical Cluster Analysis (HCA): 4/15 farms improved their biosecurity only in the professional zone, 8/15 showed scarce/null improvement of total biosecurity, 2/15 worsened their biosecurity, and 1/15 greatly improved biosecurity. The farm biosecurity profiles showing an improvement included farms with a reduction in lung lesions and scars at slaughter at the end of the study. The results suggest that a systematic evaluation of biosecurity is a useful approach to formulate tailor-made biosecurity plans and monitor their implementation; biomarkers might bring insight into the outcomes of biosecurity.

In organic farms, hens can freely access the outdoor areas, a potential source of helminth infections. This study aimed to evaluate the effective use of free-range access in organic laying hen’s farms located in Italy. The other objective was to quantify the major risk factors for endo- and ectoparasite infestation and its effect on performance, health and welfare, correlated to the use of free-range access. Fifteen organic farms of laying hens were assessed and visited twice. The total number of hens in the three zones was counted and recorded three times daily. Indirect indicators (characteristics of vegetation cover, amount and weight of droppings) were recorded. To evaluate parasite infestation, 15 fresh faecal samples per flock were collected from the ground/floor or perches. From seven farms, 15 gastrointestinal tracts from end-of-lay hens were qualitatively and quantitatively examined for the presence of endoparasites at different developmental stages. The percentage of hens observed outdoors in zone 3 was affected by free-range features. As expected, zone 1 was more frequented by hens than the others. The correlations among number and weight of droppings collected outside, vegetation score and the percentage of hens showed interesting results. Only three species of parasites were found during faecal samples analysis. There was a significantly and positively correlation between the number of Capillaria and Ascaridia eggs. The results showed that the presence in the free-range area of mounds, trees and bushes attracted more animals outside and allowed them to show their natural behaviour.Highlights Consumer’s motivations to buy organic food are related to human health, environmental concerns and animal welfare. The higher animal welfare standards of organic production lead consumers to buy organic instead of conventional food of animal origin. However, some health and welfare problems that could affect organic egg production need to be addressed. The characteristics of the outdoor range are one of the factors that can most affect its use. Moreover, the use of the free range is considered one of the major risk factors for endo- and ectoparasite infestation in organic layers that can affect performance, health and welfare.

Summary: Background: Hospital healthcare workers (HCW), in particular those involved in the clinical care of COVID-19 cases, are presumably exposed to a higher risk of acquiring the disease than the general population. Methods: Between April 16 and 30, 2020 we conducted a prospective, SARS-CoV-2 seroprevalence study in HCWs in Southern Switzerland. Participants were hospital personnel with varying COVID-19 exposure risk depending on job function and working site. They provided personal information (including age, sex, occupation, and medical history) and self-reported COVID-19 symptoms. Odds ratio (OR) of seropositivity to IgG antibodies was estimated by univariate and multivariate logistic regressions. Findings: Among 4726 participants, IgG antibodies to SARS-CoV-2 were detected in 9.6% of the HCWs. Seropositivity was higher among HCWs working on COVID-19 wards (14.1% (11.9–16.5)) compared to other hospital areas at medium (10.7% (7.6–14.6)) or low risk exposure (7.3% (6.4–8.3)). OR for high vs. medium wards risk exposure was 1.42 (0.91–2.22), P = 0.119, and 1.98 (1.55–2.53), P

Pig welfare is affected by housing conditions, the minimum requirements of which are set up by EU legislation. Animal and non-animal-based measures are useful indicators to investigate housing risk factors for pig welfare. An observational study on 51 pig farms in seven EU countries, aimed at investigating housing risk factors for the welfare of finishing pigs, showed body weight and presence of bedded solid floored resting area (BED) identifying three clusters of farms. Farms with BED were featured by no or limited tail docking, larger availability of manipulable materials and lower number of pigs per farm and per annual work unit. In these farms, less skin and ear lesions were found, compared with lean pigs of farms without BED, which were characterized by lower pig space allowance, mortality rate and medication cost. In farms without BED, heavy pigs were featured by more space per pig, more pigs per drinker and higher mortality rate and medication cost per pig, compared to lean pigs. No statistical difference in tail lesions was found between the three farm clusters, although tail docking was performed in all farms without BED and not performed on most farms with BED.

Laparoscopic liver resections have gained widespread popularity among hepatobiliary surgeons and is nowadays performed for both standard and more complex hepatectomies. Given the increased technical challenges, preoperative planning and intraoperative guidance is pivotal in laparoscopic surgery to safely carry out complex and oncologically safe hepatectomies. Modern tools can help both preoperatively and intraoperatively and allow surgeons to perform more precise hepatectomies. Preoperative 3D reconstructions and printing as well as augmented reality can increase the knowledge of the specific anatomy of the case and therefore plan the surgery accordingly and tailor the procedure on the patient. Furthermore, the indocyanine green retention dye is an increasingly used tool that can nowadays improve the precision during laparoscopic hepatectomies, especially when considering anatomical resection. The use of preoperative modern imaging and intraoperative indocyanine green dye are key to successfully perform complex hepatectomies such as laparoscopic parenchymal sparing liver resections. In this narrative review, we discuss the aspects of preoperative and intraoperative tools that are nowadays increasingly used in experienced hepatobiliary centers.

Currently, the applications of the Internet of Things (IoT) generate a large amount of sensor data at a very high pace, making it a challenge to collect and store the data. This scenario brings about the need for effective data compression algorithms to make the data manageable among tiny and battery-powered devices and, more importantly, shareable across the network. Additionally, considering that, very often, wireless communications (e.g., low-power wide-area networks) are adopted to connect field devices, user payload compression can also provide benefits derived from better spectrum usage, which in turn can result in advantages for high-density application scenarios. As a result of this increase in the number of connected devices, a new concept has emerged, called TinyML. It enables the use of machine learning on tiny, computationally restrained devices. This allows intelligent devices to analyze and interpret data locally and in real time. Therefore, this work presents a new data compression solution (algorithm) for the IoT that leverages the TinyML perspective. The new approach is called the Tiny Anomaly Compressor (TAC) and is based on data eccentricity. TAC does not require previously established mathematical models or any assumptions about the underlying data distribution. In order to test the effectiveness of the proposed solution and validate it, a comparative analysis was performed on two real-world datasets with two other algorithms from the literature (namely Swing Door Trending (SDT) and the Discrete Cosine Transform (DCT)). It was found that the TAC algorithm showed promising results, achieving a maximum compression rate of 98.33%. Additionally, it also surpassed the two other models regarding the compression error and peak signal-to-noise ratio in all cases.

Abstract Background PET/CT has recently been shown to be a viable alternative to traditional post-infusion imaging methods providing good quality images of 90Y-laden microspheres after selective internal radiation therapy (SIRT). In the present paper, first we assessed the quantitative accuracy of 90Y-PET using an anthropomorphic phantom provided with lungs, liver, spine, and a cylindrical homemade lesion located into the hepatic compartment. Then, we explored the accuracy of different computational approaches on dose calculation, including (I) direct Monte Carlo radiation transport using Raydose, (II) Kernel convolution using Philips Stratos, (III) local deposition algorithm, (IV) Monte Carlo technique (MCNP) considering a uniform activity distribution, and (V) MIRD (Medical Internal Radiation Dose) analytical approach. Finally, calculated absorbed doses were compared with those obtained performing measurements with LiF:Mg,Cu,P TLD chips in a liquid environment. Results Our results indicate that despite 90Y-PET being likely to provide high-resolution images, the 90Y low branch ratio, along with other image-degrading factors, may produce non-uniform activity maps, even in the presence of uniform activity. A systematic underestimation of the recovered activity, both for the tumor insert and for the liver background, was found. This is particularly true if no partial volume correction is applied through recovery coefficients. All dose algorithms performed well, the worst case scenario providing an agreement between absorbed dose evaluations within 20%. Average absorbed doses determined with the local deposition method are in excellent agreement with those obtained using the MIRD and the kernel-convolution dose calculation approach. Finally, absorbed dose assessed with MC codes are in good agreement with those obtained using TLD in liquid solution, thus confirming the soundness of both calculation approaches. This is especially true for Raydose, which provided an absorbed dose value within 3% of the measured dose, well within the stated uncertainties. Conclusions Patient-specific dosimetry is possible even in a scenario with low true coincidences and high random fraction, as in 90Y–PET imaging, granted that accurate absolute PET calibration is performed and acquisition times are sufficiently long. Despite Monte Carlo calculations seeming to outperform all dose estimation algorithms, our data provide a strong argument for encouraging the use of the local deposition algorithm for routine 90Y dosimetry based on PET/CT imaging, due to its simplicity of implementation.

Il ruolo rilevante dell’industria bellica italiana nel periodo successivo all’armistizio dell’8 settembre 1943 trova maggiori riscontri nella documentazione tedesca che negli studi sulla Rsi. Dai primi studi del 1993 le ricerche si sono sviluppate acquisendo una documentazione che ci consente di avere un quadro più articolato del contributo italiano allo sforzo bellico del Terzo Reich attraverso la prospettiva delle autorità di occupazione tedesche civili e militari e dei loro spesso divergenti obiettivi. La resa tedesca orchestrata in Svizzera contribuì a traghettare l’industria dell’Italia settentrionale verso la guerra fredda, analogamente a quanto avvenne in Occidente negli altri paesi occupati.

In the European research project HealthyHens, welfare indicators as well as husbandry and management conditions were recorded in 107 organic laying hen farms in eight countries. Farms were visited at peak and end of lay. Egg production was on average comparable to breeder specifications. A mean mortality of 5.7% and mean prevalences of footpad lesions of 30.5%, keel bone damage of 44.5%, 57.3% of flocks with on average >200 Ascarid eggs per gram faeces and 28.2% of flocks with >100 mites/trap were recorded. A large variation between flocks indicated options for improvement. Based on the results, the following measures can be recommended: (i) decreasing mite and worm infestation and (ii) providing an attractive covered veranda, because of their association with decreased mortality; (iii) maximising access to the free range, because of its relation to decreased A. galli infection and less injurious pecking; (iv) feeding sufficient protein levels and (v) providing adequate litter as preventive measure against feather pecking and cannibalism; (vi) ensuring that the birds have sufficient weight and (vii) preventing accidents by adequate hen house facilities and light conditions to reduce keel bone damage. These primarily management-based measures have the potential to improve bird welfare both in terms of behavioural and health aspects.

The adoption of the distributed generation paradigm is introducing several changes in the design and operation of modern distribution networks. Modern grid codes are becoming more and more complex, and the adoption of smart protection systems is becoming mandatory. However, the adoption of newer and smarter units is only half of the story. Proper communication networks must be provided as well, and the overall costs may become critical. In this work, the adoption of the Long-Range Wide Area Network (LoRaWAN) technology is suggested as a viable approach to implement the coordination of Interface Protection Systems. A proper communication architecture based on the LoRaWAN Class B technology was proposed and evaluated in order to assess its feasibility for the considered application. A scalability analysis was carried out, by computing the number of devices that can be handled by a single LoRaWAN Gateway (GW) and the maximum expected time of response between a triggering event and the arrival of the related coordination command. The results of the study showed that up to 312 devices can be managed by a single GW, by assuring a maximum response time of 22.95 s. A faster maximum response time of 6.2 s is also possible by reducing the number of managed devices to 12.

The application of the most recent advances of the Internet-of-Things (IoT) technology to the automation of buildings is emerging as a promising solution to achieve greater efficiencies in energy consumption, and to allow the realization of sustainable models. The application of IoT has been demonstrated as effective in many fields, such as confirmed, for instance, by the Industry 4.0 concepts, which are revolutionizing modern production chains. By following this approach, the use of distributed control architectures and of IoT technologies (both wired and wireless) would result in effective solutions for the management of smart environments composed of groups of buildings, such as campuses. In this case, heterogeneous IoT solutions are typically adopted to satisfy the requirements of the very diverse possible scenarios (e.g., indoor versus outdoor coverage, mobile versus fixed nodes, just to mention a few), making their large-scale integration cumbersome. To cope with this issue, this paper presents an IoT architecture able to transparently manage different communication protocols in smart environments, and investigates its possible application for the monitoring and control of distributed energy resources in a smart campus. In particular, a use−case focused on the integration of the Long Range Wide Area Network (LoRaWAN) technology is considered to cope with heterogeneous indoor and outdoor communication scenarios. The feasibility analysis of the proposed solution is carried out by computing the scalability limits of the approach, based on the proposed smart campus data model. The results of the study showed that the proposed solution would be able to manage more than 10,000 nodes. An experimental validation of the LoRaWAN technology confirms its suitability in terms of coverage and latency, with a minimum LoRaWAN cell coverage range of 250 m, and a communication latency of about 400 ms. Finally, the advantages of the proposed solution in the supervision and management of a PV system are highlighted in a real-world scenario.

The memory and historiography of the First World War in Italy may be divided into four broad periods. During the immediate post-war period (1918-1922) debate mainly focused on such issues as the Italian defeat at Caporetto in 1917, the human and material costs of the war, and the peace treaty. In the subsequent decades (1922-1960), fascism was presented as the heir of the war, which became a fundamental element of its nationalist identity as well as part of the rituals of the regime. This nationalistic and fascist interpretation of the conflict then survived in many respects until the start of the 1960s. Perspectives on the war were subsequently revised over the next twenty years (1960-1980). The new cultural tendencies of these decades produced a history of the conflict from below, which encompassed the experiences of Italian soldiers, who were often seen as victims of the military machine. The historiography focused on their opposition to the war, including cases of indiscipline and mental breakdown. In more recent times (1980-2014) these trends have continued, and new studies have emerged, but many aspects of the war, including the home front and the international context (including Italy’s enemies) are still relatively neglected. Moreover, although there is a keen public interest in the First World War in north-east Italy, which was the theatre of operations, the period 1915-1918 is probably part of a faraway past for most Italians.

One of the first standards in the wireless sensor networks domain,WirelessHART (HART (Highway Addressable Remote Transducer)), was introduced to address industrial process automation and control requirements. This standard can be used as a reference point to evaluate other wireless protocols in the domain of industrial monitoring and control. This makes it worthwhile to set up a reliable WirelessHART simulator in order to achieve that reference point in a relatively easy manner. Moreover, it offers an alternative to expensive testbeds for testing and evaluating the performance of WirelessHART. This paper explains our implementation of WirelessHART in the NS-2 network simulator. According to our knowledge, this is the first implementation that supports the WirelessHART network manager, as well as the whole stack (all OSI (Open Systems Interconnection model) layers) of the WirelessHART standard. It also explains our effort to validate the correctness of our implementation, namely through the validation of the implementation of the WirelessHART stack protocol and of the network manager. We use sniffed traffic from a realWirelessHART testbed installed in the Idrolab plant for these validations. This confirms the validity of our simulator. Empirical analysis shows that the simulated results are nearly comparable to the results obtained from real networks. We also demonstrate the versatility and usability of our implementation by providing some further evaluation results in diverse scenarios. For example, we evaluate the performance of the WirelessHART network by applying incremental interference in a multi-hop network.

Human errors are probably the most critical cause of the large amount of medical accidents. Medical cyber-physical systems (MCPS) have been suggested as a possible approach for detecting and limiting the impact of errors and wrong procedures. However, during the initial development phase of medical instruments, regular MCPS systems are not a viable approach, because of the high costs of repeating complex validation procedures, due to modifications of the prototype instrument. In this work, a communication architecture, inspired by recent Internet of Things (IoT) advances, is proposed for connecting prototype instruments to the cloud, to allow direct and real-time interaction between developers and instrument operators. Without loss of generality, a real-world use case is addressed, dealing with the use of transcranial magnetic stimulation (TMS) for neurodegenerative disease diagnosis. The proposed infrastructure leverages on a message-oriented middleware, complemented by historical database for further data processing. Two of the most diffused protocols for cloud data exchange (MQTT and AMQP) have been investigated. The experimental setup has been focused on the real-time performance, which are the most challenging requirements. Time-related metrics confirm the feasibility of the proposed approach, resulting in an end-to-end delay on the order of few tens of milliseconds for local networks and up to few hundreds of milliseconds for geographical scale networks.

Objective: Recurrence of urolithiasis is frequent. There are no reliable markers able to indicate recurrent stone former patients. Fetuin-A inhibits hydroxyapatite crystals formation and expansion. This study aims at evaluating whether serum fetuin-A may predict recurrent urolithiasis in young adults. Materials and methods: This is a multicentre study. Young adults patients with recurrent urolithiasis attending 3 urology clinics were enrolled from July 2011 to December 2012. Inclusion criteria were: age 18-40 years, presence of more than one kidney stone. Exclusion criteria were: diabetes mellitus, metabolic disorders, obesity, hypertension, cardiovascular disease, infection diseases. Controls were participants without history of urolithiasis and currently undetected stones. Routine biochemistry, serum concentration of oxalate, fetuin-A, and parathyroid hormone (PTH) were assessed; 24/h urinary excretion of creatinine, uric acid, calcium, sodium, phosphorus, potassium, magnesium, glucose, oxalate, amylase, and protein was measured. Kidney ultrasonography and plain X-ray examination was performed. Results: The total cohort was represented by 120 young adults participants (90 patients, and 30 controls). Clinical characteristics were not different between patients and controls. No significant differences were found in serum concentrations as well as in 24/h urinary excretion of recorded variables. No significant difference was found in serum concentration of fetuin-A (median 35.1 ± 18.62 SD Vs 35.12 ± 14.12, μg/ml; p = 0,908). Conclusions: The data of present study do not substantiate the hypothesis that serum fetuin-A may be a reliable predictor of recurrent urolithiasis in young adults.

Information about animal welfare standards and initiatives from eight European countries was collected, grouped, and compared to EU welfare standards to detect those aspects beyond minimum welfare levels demanded by EU welfare legislation. Literature was reviewed to determine the scientific relevance of standards and initiatives, and those aspects going beyond minimum EU standards. Standards and initiatives were assessed to determine their strengths and weaknesses regarding animal welfare. Attitudes of stakeholders in the improvement of animal welfare were determined through a Policy Delphi exercise. Social perception of animal welfare, economic implications of upraising welfare levels, and differences between countries were considered. Literature review revealed that on-farm space allowance, climate control, and environmental enrichment are relevant for all animal categories. Experts’ assessment revealed that on-farm prevention of thermal stress, air quality, and races and passageways’ design were not sufficiently included. Stakeholders considered that housing conditions are particularly relevant regarding animal welfare, and that animal-based and farm-level indicators are fundamental to monitor the progress of animal welfare. The most notable differences between what society offers and what farm animals are likely to need are related to transportation and space availability, with economic constraints being the most plausible explanation.

Despite availability of effective antihypertensives, blood pressure (BP) control is usually inadequate. The Reasons for not Intensifying Antihypertensive Treatment (RIAT) registry evaluated the reasons behind not modifying treatment in an international, cross-sectional study in 16 countries. Methods and results: The Taiwanese cohort of RIAT consisted of 8922 patients with untreated/uncontrolled essential hypertension recruited from 22 centers in the country. At the first visit, physicians selected target BP and antihypertensive treatment, and at the next three visits they measured BP and modified treatment/provided justification for not modifying treatment. Mean target BP selected by physicians was 134.6/84.6 ± 5.1/5.0 mmHg, respectively. Patients’ individual risk stratification determined the BP goals. More patients achieved targets according to the physicians’ opinion than based on actual BP measurements: visit 2–50.6% vs. 48.6%; visit 3–58.4% vs. 55.2%; and visit 4–61.2% vs. 57.0%. At each visit, treatment remained unchanged for >60% patients not reaching target; the most common reason for this at visit 2 was the assumption that the time was too short to assess new drug therapy and at visits 3 and 4 was the assumption that target was reached/had almost been reached. Conclusion: About 40% Taiwanese hypertensive patients in RIAT did not reach BP targets after an average of 4 months’ follow-up. The most common reason for not modifying treatment was the assumption that the target had been reached or had almost been reached.

In the last decade, the growth of the automotive market with the aid of technologies has been notable for the economic, automotive and technological sectors. Alongside this growing recognition, the so called Internet of Intelligent Vehicles (IoIV) emerges as an evolution of the Internet of Things (IoT) applied to the automotive sector. Closely related to IoIV, emerges the concept of Industrial Internet of Things (IIoT), which is the current revolution seen in industrial automation. IIoT, in its turn, relates to the concept of Industry 4.0, that is used to represent the current Industrial Revolution. This revolution, however, involves different areas: from manufacturing to healthcare. The Industry 4.0 can create value during the entire product lifecycle, promoting customer feedback, that is, having information about the product history throughout it is life. In this way, the automatic communication between vehicle and factory was facilitated, allowing the accomplishment of different analysis regarding vehicles, such as the identification of a behavioral pattern through historical driver usage, fuel consumption, maintenance indicators, so on. Thus, allowing the prevention of critical issues and undesired behaviors, since the automakers lose contact with the vehicle after the purchase. Therefore, this paper aims to propose a customer feedback platform for vehicle manufacturing in Industry 4.0 context, capable of collecting and analyzing, through an OBD-II (On-Board Diagnostics) scanner, the sensors available by vehicles, with the purpose of assisting in the management, prevention, and mitigation of different vehicular problems. An intercontinental evaluation conducted between Brazil and Italy locations shown the feasibility of platform and the potential to use in order to improve the vehicle manufacturing process.

The rising concerns about global warming and environmental pollution are increasingly pushing towards the replacement of road vehicles powered by Internal Combustion Engines (ICEs). Electric Vehicles (EVs) are generally considered the best candidates for this transition, however, existing power grids and EV management systems are not yet ready for a large penetration of EVs, and the current opinion of the scientific community is that further research must be done in this field. The so-called Vehicle-to-Grid (V2G) concept plays a relevant role in this scenario by providing the communication capabilities required by advanced control and Demand-Side Management (DSM) strategies. Following this research trend, in this paper the communication requirements for the DSM of EVs in urban environments are discussed, by focusing on the mobile communication among EVs and smart grids. A specific system architecture for the DSM of EVs moving inside urban areas is proposed and discussed in terms of the required data throughput. In addition, the use of a Low-Power Wide-Area Network (LPWAN) solution—the Long-Range Wide Area Network (LoRaWAN) technology—is proposed as a possible alternative to cellular-like solutions, by testing an experimental communication infrastructure in a real environment. The results show that the proposed LPWAN technology is capable to handle an adequate amount of information for the considered application, and that one LoRa base station is able to serve up to 438 EVs per cell, and 1408 EV charging points.

Background: Erythropoiesis stimulating agent (ESA)-resistant anemia is common in chronic kidney disease (CKD). Objectives: To evaluate the determinants of severity of ESA resistance in patients with CKD and primary ESA-resistance. Design: Secondary analysis of a randomized controlled trial (the Handling Erythropoietin Resistance with Oxpentifylline, HERO) Setting and patients: 53 adult patients with CKD stage 4 or 5 and primary ESA-resistant anemia (hemoglobin ≤120 g/L, ESA resistance index [ERI] ≥1.0 IU/kg/week/gHb for erythropoietin or ≥0.005 μg/kg/week/gHb for darbepoeitin, no cause for ESA-resistance identified). Measurements: Iron studies, parathyroid hormone, albumin, liver enzymes, phosphate or markers of oxidative stress and inflammation. Methods: Participants were divided into tertiles of ERI. Multinomial logistic regression was used to analyse the determinants of ERI tertiles. Results: All patients, except one, were receiving dialysis for end-stage kidney disease. The mean ± SD ERI values in the low ( n = 18), medium ( n = 18) and high ( n = 17) ERI tertiles were 1.4 ± 0.3, 2.3 ± 0.2 and 3.5 ± 0.8 IU/kg/week/gHb, respectively ( P < 0.001). There were no significant differences observed in age, gender, ethnicity, cause of kidney disease, diabetes, iron studies, parathyroid hormone, albumin, liver enzymes, phosphate or markers of oxidative stress and inflammation between the ERI tertiles. The median [inter-quartile range] serum alkaline phosphatase concentrations in the low, medium and high ERI tertiles were 89 [64,121], 99 [76,134 and 148 [87,175] U/L, respectively ( P = 0.054). There was a weak but statistically significant association between ERI and serum alkaline phosphatase (R 2 = 0.06, P = 0.03). Using multinomial logistic regression, the risk of being in the high ERI tertile relative to the low ERI tertile increased with increasing serum alkaline phosphatase levels ( P = 0.02). No other variables were significantly associated with ERI. Limitations: Small sample size; bone-specific alkaline phosphatase, other markers of bone turnover and bone biopsies not evaluated. Conclusions: Serum alkaline phosphatase was associated with severity of ESA resistance in ESA-resistant patients with CKD. Large prospective studies are required to confirm this association. (Trial registration: Australian New Zealand Clinical Trials Registry 12608000199314)

Growing incidence of end-stage renal disease, shortage of kidneys from deceased donors and a better outcome for recipients of kidneys from living donor have led many centres worldwide to favour living donor kidney transplantation programmes. Although criteria for living donation have greatly evolved in recent years with acceptance of related and unrelated donors, an immunological incompatibility, either due to ABO incompatibility and/or to positive cross-match, between a living donor and the intended recipient, could impede up to 40% of such procedures. To avoid refusal of willing and healthy living donors, a number of strategies have emerged to overcome immunological incompatibilities. Kidney paired donation is the safest way for such patients to undergo kidney transplantation. Implemented with success in many countries either as national or multiple regional independent programmes, it could include simple exchanges between any number of incompatible pairs, incorporate compatible pairs and non-directed donors (NDDs) to start a chain of compatible transplantations, lead to acceptance of ABO-incompatible matching, and integrate desensitising protocols. Incorporating all variations of kidney paired donation, the Australian programme has been able to facilitate kidney transplantation in 49% of registered incompatible pairs. This review is a plea for implementing a national kidney paired donation programme in Switzerland.

The paper presents an equilibrium model in asymmetric multimodal transport networks with capacity constrains. It is shown that these networks may have no equilibrium flow pattern which satisfies the capacity constrains, but additional costs can be imposed on some network links, so that an equilibrium solution that satisfies the capacity constrains always exists. A method of computing both the equilibrium flow pattern and the additional costs is presented and is used in a simple numerical example.